The following are key points from the 2015 AHA pediatric advanced life support cardiopulmonary resuscitation (CPR) guidelines update (part 12):

Survival from pediatric in-hospital cardiac arrest has improved to approximately 43%.

Prolonged CPR is not futile; 12% of those who received CPR for >35 minutes survived, and 60% had favorable neurologic outcomes.

Pre-arrest care updates:

Pediatric rapid response teams and the use of pediatric early warning scores in non–intensive care unit, general in-patient units may reduce mortality, but data are contradictory and inconsistent. Their use may be considered where high-risk children are cared for in general in-patient floors.

In septic shock, a fluid bolus of up to 20 cc/kg is reasonable, but further boluses should be guided by individualized evaluation.

The routine use of pre-intubation atropine during emergency intubation is not supported by available evidence, but may be considered.

Veno-arterial extracorporeal membrane oxygenation (ECMO) may be considered in acute fulminant myocarditis at risk for imminent arrest.

Intra-arrest care updates:

ECMO CPR (ECPR) may be considered in those with a surgical cardiac diagnosis. Outcome after ECPR is better for those with underlying cardiac disease than for those without.

End-tidal CO2 and invasive hemodynamic monitoring may be considered to evaluate quality of CPR, but specific values have not been established.